Chinese Medicine in the Middle Ages: Mongol Invasion and the Yuan Dynasty

Chinese medicine in the Middle Ages: an overview

Chinese medicine in the Middle Ages advanced through struggle and mutual criticism among medical practitioners, which created favourable conditions for further progress in the field — although those conditions were never fully exploited. This long medieval arc, stretching across foreign conquest and native restoration, shaped how diagnosis, herbal pharmacology, and the training of physicians developed in China. To follow that story, it helps to place it alongside the broader currents of China before the twelfth century, the medical systems of neighbouring civilisations, and the history of medicine as a whole.

Definition and terminology of Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is the body of diagnostic and therapeutic practice that grew out of centuries of Chinese healing tradition, built on concepts such as Qi (vital energy), the balance of yin and yang, and channels or meridians through which vital force is believed to flow. Its core techniques include acupuncture, herbal medicine, cupping, and dietary regulation. Scholars such as Nathan Sivin and Charles Leslie have noted that the modern label "Traditional Chinese Medicine" is partly a twentieth-century construction, standardising a diverse historical practice into a coherent, teachable system. In the medieval period the tradition had no single name of this kind; it was simply the accumulated craft of physicians, herbalists, and scholar-officials.

Historical development and early medical practices

The medical culture that entered the Middle Ages rested on foundations laid many centuries earlier. Classical texts such as the Huangdi Neijing (the Yellow Emperor's Inner Canon) had already set out the theoretical framework of Qi, yin-yang, and the five phases, giving later physicians a shared vocabulary for describing illness and treatment. The medieval physician inherited this literature and was expected to master it before practising.

Ancient medical history and Shang dynasty practices

The earliest documented Chinese medical activity reaches back to the Shang dynasty, whose oracle-bone inscriptions record illnesses, afflicted body parts, and appeals to ancestors for healing. These Shang dynasty practices blended religious divination with early observation of the body, and they mark the point at which Chinese healing begins to leave a written trace. By the medieval centuries this magical-religious inheritance coexisted with a far more systematic, text-based medicine, yet echoes of the older superstition and ancestral appeal never entirely vanished from practice.

The Mongol invasion and its effect on medicine

The Mongol invasion, which began in 1211 and culminated in the conquest of China in 1280, brought foreign rulers and, with them, a system of harsh oppression and terror. Thousands of Chinese were enslaved, hundreds of thousands more were tied to lands handed over as fiefs to Mongol khans, and enemy garrisons entrenched themselves in the cities. This upheaval weighed heavily on Chinese culture, and medicine felt its effects directly.

The Yuan period: the decline of Chinese medicine

Because the conquerors stood considerably below the conquered in cultural terms, Chinese medicine unmistakably declined to some degree during the roughly century-long Yuan period. The free practice of physicians was sharply curtailed. For their own security, the occupiers even withdrew all potent and poisonous medicines from circulation, cutting practitioners off from a substantial part of their pharmacopoeia. With the exception of one genuinely productive development described below, the era of Mongol domination was a "black day" for Chinese medicine.

Restrictions and bans imposed by the conquerors

The Yuan rulers introduced many prohibitions that hemmed in the physician's work. Beyond banning strong and toxic remedies, they restricted where and how doctors could practise, subordinating a once-independent profession to the interests of occupation and control. These constraints slowed the transmission of knowledge and discouraged the experimentation that had previously driven the field forward.

Arab medicine in China: an exchange of knowledge

The single positive current of the Mongol era was the arrival of Arab medicine in the Chinese capital. When, in the mid-thirteenth century and before the final conquest of China, the Mongols marched west and subjugated the Arab lands, many captive Arab physicians were brought to Beijing, the seat of the Yuan dynasty. There Chinese medicine and Arab medicine existed side by side, and their practitioners exchanged the experience each tradition had accumulated — the Chinese drawing on knowledge built up in China before the twelfth century. This meeting introduced new drugs, recipes, and diagnostic ideas into the Chinese setting.

Arab versus European medical knowledge

Arab medicine reaching China in this period was, in several respects, more advanced than its contemporary European counterpart. While the Roman Catholic Church shaped and often constrained medical practice in medieval Europe, Arab physicians preserved and extended the classical Greek inheritance of Hippocrates and Galen, whose theory of the four humours dominated Western thought. In Europe that Greek legacy survived largely through translation: figures such as Constantine the African brought Arabic medical texts to Salerno, and centres like Montpellier, Bologna, and the Byzantine world of Constantinople transmitted the works of Dioscorides and Pliny's Naturalis Historia. Arab scholars, meanwhile, had already systematised pharmacology and surgery to a level that made the exchange in Yuan Beijing a meeting of two comparatively sophisticated traditions.

Expelling the invaders and restoring the state

The credit for expelling the invaders belonged, as always, to the people, who took up arms and rose in a war of liberation, forming the bands known as the "Red Turbans." Leaders emerged from among the common people. After seizing Beijing and finally crushing the Mongols, the rebel commander Zhu Yuanzhang — himself of peasant origin — became emperor of the new Ming dynasty in 1368, only to suppress the popular movement harshly and restore the feudal state.

Although commodity-money relations, craft production, and manufactories developed further under the new order, remnants of earlier feudal arrangements persisted. Their durability owed much to the pairing of agriculture with certain branches of domestic industry, above all hand spinning and weaving, which kept peasant households bound to both field and loom.

In the large cities, manufactories rested on a considerable division of labour and could therefore serve a wide market. Into thirty-three major trading centres flowed goods not only from across China but also from Africa, Indochina, Ceylon, India, and the islands of Indonesia.

The Ming dynasty and the consolidation of Chinese medicine

Under the Ming dynasty, Chinese medicine reasserted itself, funded by the wealth that expanding trade brought to the ruling class. Extensive commerce with many countries, combined with the ruthless exploitation of the common people, allowed the dominant class to accumulate enormous riches — and it could well afford to spend part of these funds on medicine.

The growth of trade and the naval expeditions of Zheng He

The maritime expeditions of the eunuch admiral Zheng He, who led the seven most successful voyages, won China profitable trading colonies and established dominance over the main routes of the Pacific and Indian Oceans. This expansion of overseas contact carried a direct medical benefit: lively exchange with other countries acquainted Chinese physicians with a range of new medicinal plants, while China in turn exported medicinal raw materials, whose collection was imposed on the peasantry as a form of tribute in kind.

The medical academy and the training of physicians

The restored medical academy — and indeed the whole apparatus of medicine under the Ming — served almost exclusively the needs of the imperial court, high officials, and, to a limited degree, the army. Even leading posts in the academy were awarded to members of the nobility who often had nothing to do with medicine and who championed a scholastic system of education steeped in medieval mysticism and religion.

Formal medical schools and education

Only a very small number of physicians held state service in the capital and the principal provincial cities; the majority practised privately. Assessing the qualifications of physicians was at first the task of special officials, but this function soon passed to dedicated schools. The chief purpose of these schools was to train doctors to serve the nobility of a given province, and they also organised medical provision within that province.

Traditional apprenticeship and the transmission of knowledge

Most physicians acquired their knowledge through traditional apprenticeship under their fathers, and the profession was hereditary by law. A state act barred sons from abandoning the calling, so that many doctors could count several generations of physicians among their ancestors. A physician's standing — even his presumed knowledge — was measured against this genealogy: the more ancestors of the same profession in his line, the more respected and skilled he was held to be. Under the Song era, only those who had inherited the medical profession through at least three generations were officially permitted to practise independently.

The legal position of physicians

The regulation of medical activity continued into the Ming era, and the criminal code of the period contained strikingly severe rules. One required a physician to use only "the methods and remedies established and sanctioned by science" — that is, by the canonical texts — and the law fixed strict liability for a patient's life. If a patient died from a prescribed medicine even when the physician had observed every rule of treatment, the case was classed as death from careless handling of medical means, and the doctor could be sentenced to hanging. If, through negligence, he erred in applying the rules and the patient died, he was charged with murder and executed by beheading.

A physician's place of residence was strictly fixed, and changing it was categorically forbidden. All of this meant that the legal position of physicians was far from enviable: they were equated with artisans whose trades were likewise passed down by inheritance, and ordinary doctors suffered considerable material hardship. Even so, popular healers not only refused to abandon their noble work but constantly strove to improve the existing methods and means of treatment.

Access to medical care by social class

Access to medical care in medieval China was sharply stratified by social class. The most qualified physicians, and the resources of the state medical academy, were reserved for the emperor, the court, and the higher nobility. Provincial elites and wealthy merchants drew on trained doctors attached to their regions, while the peasantry and the urban poor relied largely on folk healers, herbalists, and private practitioners who worked among ordinary people — often for payment as modest as a single gourd left in gratitude.

Diagnostic methods in medieval medicine

Diagnosis in medieval Chinese medicine relied above all on pulse examination, inspection of the patient, questioning, and the reading of external signs, all interpreted through the theory of Qi and the balance of yin and yang. Pulse diagnosis was so central that specialised treatises were devoted to it — Li Shizhen himself wrote a "Book of Pulses." This contrasts with the medieval European reliance on the theory of the four humours, where practitioners often turned to urine examination, inspecting a patient's urine for colour and sediment to infer the state of the body. In both traditions, careful observation of visible signs stood at the heart of the diagnostic art.

Treatment methods in medieval Chinese medicine

Treatment in medieval Chinese medicine combined acupuncture, herbal remedies, cupping, and dietary regulation, aimed at restoring the balance of Qi. Herbal medicine formed the largest part of the therapeutic arsenal, supplemented by physical techniques and by remedies that reflected the beliefs of the age. Comparing these methods with those used in medieval Europe illuminates both what the traditions shared and where they diverged.

Bloodletting, cupping, and leeching treatments

Bloodletting, cupping, and the application of leeches were treatments common to both Chinese and European medieval medicine. Cupping — drawing blood to the surface with heated vessels — remained a standard Chinese technique and is still used in TCM today. In Europe, bloodletting and the use of leeches followed from the theory of the four humours, which held that illness arose from an imbalance of blood, phlegm, and the two biles; texts such as the Anglo-Saxon Leech Book of Bald recorded such remedies. Leeches were valued for drawing blood from a precise site with little effort.

Fracture and bone treatment

The care of broken bones was one of the more effective branches of medieval practice. Chinese medicine developed methods of setting and immobilising fractures that drew on long practical experience, and skeletal remains studied by archaeologists show that many fractures healed in good alignment. Bone-setting, unlike much of the pharmacological tradition, produced results that can still be assessed and confirmed by physical evidence.

The doctrine of signatures in herbal medicine

The doctrine of signatures — the belief that a plant's outward form reveals the ailment it treats — shaped herbal medicine across many premodern cultures, so that a heart-shaped leaf might be used for the heart, or a yellow flower for jaundice. This mode of reasoning appears in European herbals and finds parallels in the reasoning behind some traditional Chinese remedies. It illustrates how observation and symbolic association were interwoven in medieval pharmacology, sometimes yielding useful drugs and sometimes only apparent ones.

The influence of astrology and the planets on health

Astrology and the supposed influence of the planets on the body were woven into medieval medical thinking in both East and West. Physicians timed treatments, bloodletting, and the gathering of herbs according to celestial cycles, believing that heavenly bodies governed the balance of forces within the patient. In Chinese medicine this connected to the correlative cosmology linking human health to the rhythms of nature; in Europe it linked to the humours and their planetary associations.

The influence of religion and mysticism on medical practice

Religion, superstition, and mysticism pervaded medieval medicine everywhere. In China the scholastic academy under the Ming was steeped in medieval mysticism and religious belief, and older Shang-era appeals to ancestors survived in popular healing. In medieval Europe the Roman Catholic Church dominated medical life: monastic hospitals cared for the sick, monastic herb gardens produced remedies, and monks preserved classical texts through the centuries after the fall of Rome. Wise-women and herbalists carried much of the everyday healing burden, yet the association of women's healing with magic could turn dangerous, feeding witch accusations and persecution — a fear reflected even in legend through figures like Morgan le Fay, and in theological debate reaching back to writers such as Origen. Anaesthesia and pain management, where they existed, relied on plants such as mandragora, and daring procedures like Caesarean section carried grave risk.

Comparison with other systems of traditional medicine

Traditional Chinese Medicine can be set beside the other great premodern healing systems — the humoural medicine of the classical Greek and later European world, and the Arab medicine that transmitted and extended it. Where European medicine leaned on the four humours of Hippocrates and Galen, Chinese medicine reasoned through Qi, yin-yang, and the five phases. All three shared bloodletting, herbal pharmacology, astrological timing, and a heavy overlay of religion, yet each built a distinctive theoretical scaffolding around those common practices. The Black Death, which devastated Europe and reached across Eurasia, exposed the limits of every one of these systems in the face of epidemic disease.

Archaeological evidence of treatment success

Archaeological evidence offers one of the few objective measures of medieval medical success. Human remains show healed fractures, evidence of dental extraction, and signs of survived surgery, allowing modern researchers to judge which interventions genuinely worked. Bone-setting and wound care leave physical traces that confirm real skill, whereas the effectiveness of many herbal and symbolic remedies cannot be verified from the material record. This distinction — between what can be demonstrated and what rests on belief — remains central to how historians assess premodern medicine.

Controversies and criticism of the effectiveness of Chinese medicine

The effectiveness of Traditional Chinese Medicine remains contested, with modern critics distinguishing the practices supported by scientific evidence from those regarded as pseudoscience. Some herbal compounds have yielded genuinely active drugs, and techniques such as bone-setting have clear physical value; other claims lack support from controlled study. The demand for certain animal-derived remedies has also driven wildlife smuggling and threatened endangered species, adding a conservation dimension to the debate. Historians and clinicians alike — among them writers such as Rachel Hajar, associated with the Heart Hospital of the Hamad Medical Corporation — continue to weigh the historical achievements of the tradition against the standards of contemporary evidence-based medicine.

Li Shizhen, scholar of Chinese medicine

Li Shizhen (born 1518, died 1593) holds the honour of having absorbed and critically reworked the pharmacological knowledge of the past, unifying it and carrying pharmacology further. His home was Qichun county in Hubei province, and both his grandfather and father were physicians.

Constant hardship and a lack of means led Li Shizhen's father to consider abandoning medicine to become an official, and he prepared his son for the same career, setting him to study philosophy in order to pass the state examination for officialdom. Only at the age of thirty, after failing that examination for the third time, did Li Shizhen turn to medicine. Unlike his father, the son regarded the physician's calling as a noble one and soon came to love it.

Like his father, Li Shizhen began his practice among the poor, who often, unable to pay, would leave nothing more than a single gourd in thanks for his help. Officials, rural gentry, and merchants ignored both him and his father, but the poor held them in all the greater respect. A highly educated man, Li Shizhen quickly absorbed every new finding in medicine, and his broad practice gave him a great store of personal experience.

Success in treating patients, together with complete disinterestedness, soon won him fame far beyond his own county. Studying the ancient recipes, Li Shizhen noticed clear inconsistencies and mistaken instructions, and he set himself the task of creating a new and complete pharmacopoeia.

To that end he studied thoroughly everything written about medicines in the centuries before him, carried out wide-ranging observations in nature, gathered medicinal plants, and tested their action on animals. Li Shizhen did not confine himself to the plant world but also investigated mineral substances and remedies of animal origin. The animals on which he tested drugs he dissected, examining in detail the changes wrought in their bodies. Marked by great powers of observation and diligence, he soon amassed a wealth of valuable data. To generalise his experience and study medicinal substances, Li Shizhen visited nearly every province.

Travelling through the country, he also collected recipes current among the population, gathering in this way more than ten thousand recipes, which he then carefully verified through experiment before including them in his famous work. Twenty-seven years of tireless labour produced his greatest pharmacological work, the Compendium of Materia Medica (Bencao Gangmu). He revised the work three times over those twenty-seven years, beginning it in 1552 and completing it in 1578.

The book was published only in 1596, three years after his death. It ran to fifty-two volumes — some two million characters — and described 1,892 medicines: 1,094 medicinal plants, 444 remedies made from animal products, 275 kinds of mineral origin, and 79 of other types, including descriptions of 374 remedies discovered by the author himself. It also contained more than ten thousand recipes, with each medicine given a clear and detailed account of its form, smell, colour, method of collection, and method of preparation, and more than a thousand illustrations. To create this great work Li Shizhen enlisted his whole family — children and grandchildren — some to copy, others to prepare medicines, and others to test their effects.

The Compendium of Materia Medica is a remarkable contribution not only to medieval Chinese medicine; it was translated into Latin, Russian, English, French, German, Japanese, and other languages. Its first printed edition (1606) circulated widely in Japan and was published there twice more (in 1783 and 1929). Borrowings from Li Shizhen's work appear in the "Description of the Medicinal Flora of China," issued in Latin in 1659, and individual chapters of the Russian physician A. Tatarinov's "Catalogue of Chinese Medicaments" (1857) are translations from it. Many such examples could be cited.

Li Shizhen also wrote the "Book of Pulses" (1564) and a treatise on acupuncture (1572), and he exerted an enormous influence on the development of botany in China. In China his memory is cherished with special care, and his name has become a synonym for devotion to science and service to one's people.